Risk of suicide in patients with thyroid cancer: protocol for a systematic review and meta-analysis


Worldwide, there are millions of new cancer cases per year; however, due to enhancements in techniques for diagnosis and therapy, cancer survival has also improved.1–3 In addition to cancer-related death, an increasing number of cancer survivors die of non-cancer-related causes. Elevated suicide rates among cancer survivors have been reported in many studies,4–6 and over 800 000 people die by suicide each year.7–10A previous study demonstrated that the risk of non-cancer-related deaths has exceeded that of cancer-related deaths, particularly among young patients in the year after diagnosis.11 Both cancer-related and non-cancer-related deaths have resulted in cancer being a global public health burden as well as the second leading cause of death.3 With the increased survival of cancer patients, long-term cancer support has gradually replaced short-term cancer care and has become a public health issue.

With the development of the economy and healthcare, people have become more health conscious, and governments have rolled out more nationwide cancer screening programmes; thus, the incidence of thyroid cancer has increased manyfold.12 13 Young adults, who have a greater financial burden and occupational stress, account for a large proportion of patients with thyroid cancer.14 However, as a cancer with a good prognosis,15 aggressive diagnosis and therapy are associated with a more severe mental burden for patients with thyroid cancer. After the diagnosis, lingering cancer-related depression and anxiety are persistent and plague cancer survivors, and they may result in mental illness and even suicide.13 In addition, occupational and social pressure might have a greater effect on young adult patients because of their cancer identity. Moreover, complications of surgery, such as vocal cord paralysis, hypocalcaemia and surgical scarring, might destroy patients’ careers, such as comperes, singers, performers or models; furthermore, surgery could also adversely affect day-to-day life.13 16 Otherwise, socioeconomic disparities, gender and social support were indeed closely related with suicidal ideation, especially cancer-associated suicidal ideation.17–19 Currently, the overdiagnosis and overtreatment of thyroid cancer has gradually become a topical issue, and an increasing number of researchers have called for the downgrading of cancer screening and treatment.20–22


Previous studies have shown mixed results on suicide rates among thyroid cancer survivors, and studies from different countries and regions have even revealed distinct results. It remains unclear whether thyroid cancer causes an elevated risk of suicide6 23–25 or reduces the risk of suicide.16 26–28 The study aims to summarise the risk of suicide among patients with thyroid cancer to provide robust evidence of the effects of thyroid cancer on suicide.

This post was originally published on https://bmjopen.bmj.com